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District - County - Route - Begin Post Mile/End Post MileExpenditure Authorization (EA) – Project Number – Planning Program Number (PPNO)
Program Code – Program NameMonth/Year
Project Scope Summary Report(Roadway Rehabilitation)
Enter reason(s) per Appendices L & K
On Route
Between
And
I have reviewed the right-of-way information contained in this report and the right-of-way data sheet attached hereto, and find the data to be complete, current and accurate:
(Name), DISTRICT DIVISION CHIEF, RIGHT OF WAY
APPROVAL RECOMMENDED: (delete signature block when milestone M015 has already been completed)
(Name), DISTRICT DIVISION CHIEF, PLANNING
APPROVAL RECOMMENDED:
(Name), PROJECT MANAGER
PROJECT APPROVED: (only include “PROJECT” for milestone M200 PA&ED)
(Name), DISTRICT DIRECTOR (or delegated authority) DATE
District - County - Route - Begin Post Mile/End Post MileExpenditure Authorization (EA) – Project Number – Planning Program Number (PPNO)
Program Code – Program NameMonth/Year
Vicinity Map
Insert a vicinity map, showing:
Project limits Topographical features listed in report North arrow
District - County - Route - Begin Post Mile/End Post Mile
This project scope summary report has been prepared under the direction of the following registered civil engineer. The registered civil engineer attests to the technical information contained herein and the engineering data upon which recommendations, conclusions, and decisions are based.
REGISTERED CIVIL ENGINEER DATE
Name
C12345
XX/XX/XX
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Table of ContentsAs needed, include a table of contents with the topics from the body of the report.
District - County - Route - Begin Post Mile/End Post Mile
1. INTRODUCTION
Project Description:
Describe the proposed project.
Project Limits District-County-RouteBegin Post Mile/End Post Mile
Number of Alternatives Delete row if not applicableProgrammable Project Alternative
Current CostEstimate:
Escalated Cost Estimate:
Capital Outlay SupportCapital Outlay ConstructionCapital Outlay Right-of-WayFunding Source Enter program code(s)Funding YearType of Facility #-lane conventional highway, expressway,
freewayNumber of StructuresSHOPP Project OutputAnticipated Environmental Determination or Document
Delete “Anticipated” as needed
Legal Description See the Plans Preparation Manual Section 2-2.2 heading “Title Sheet Project Descriptions”
Project Development Category See PDPM Chapter 8, Section 5
2. RECOMMENDATION
State the recommendation.
3. PURPOSE AND NEED
Purpose:State the purpose of the project.
Need:State the need for the project.
4. EXISTING FACILITY, DEFICIENCIES AND TRAFFIC DATA
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4A. Roadway Geometric Information
Existing ProposedMinimum
RRR Standards
Facility Location (Post Mile Limits) (1) (2)
Minimum Curve Radius Radius (ft)
Through Travel LanesNumber of Lanes
Lane Width (ft)
Paved ShoulderWidth Left (ft)
Width Right (ft)
Median Width (ft)
Bikeway(3)
Class Left
Width Left (ft)
Class Right
Width Right (ft)
Facilities Adjacent to Roadbed (4) Code-Width (ft)
Notes:1. Enter existing Post Mile limits (expand as needed for varied geometrics.)2. Enter proposed Post Mile limits (expand as needed for varied geometrics.)3. Bikeway Classifications:
Class I Bikeway (Bike Path)Class II Bikeway (Bike Lane)Class III Bikeway (Bike Route)Class IV Bikeway (Separated Bikeway)
4. Don’t repeat information for Class I and IV bikeways. Facility Codes:P – Pedestrian walkwayB/P – shared bicycle and pedestrian pathL – Landscaped area between the curb and sidewalk
Remarks:
Add remarks.
4B. Condition of Existing Facility (Repeat for each homogeneous segment):
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1) Traveled Way Data
PMS Category (1-29) Priority Classification (.1-.4)
International Roughness Index (IRI)
*Rigid Pavement: *Flexible Pavement:* From latest PMS-Pavement Condition Inventory Survey Data.
3rd Stage Cracking % Alligator B Cracking %
Faulting Patching %
Joint Spalls Rutting
Pumping Bleeding
Corner Breaks % Raveling
Locations(s) of subsurface or ponded surface-water problem:
Discuss.
Deflection Study Results (if available):
Discuss.
2) Shoulder Data
Condition:
Discuss.
Deficiencies
Discuss.
3) Pedestrian Facility Data
Facility Type and Location(s)(Station, post mile or other reference point)
Meets ADA Standards?(Yes or No for each listed location)
If Facility does not meet ADA Standards, what feature(s) are not ADA compliant?(List features per location)
Status of Each Noncompliant LocationUse the following statements, as appropriate: Will be corrected as part of this project; Will not be corrected to full standard. An Exception to Accessibility Design Standards has been approved.
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Curb Ramps:(List locations as appropriate)
Crosswalks:(List locations as appropriate)
Others:(List locations as appropriate)
Remarks:
Add remarks.
4) Bicycle Path Data
Deficiency Location(Station, post mile limits or other reference points)
Remarks:
Add remarks.
4C. Structures Information
Structures Width Between Curbs
Replace Bridge
Railings
Vertical Clearance Work Identified
in STRAIN
Replace Bridge
Approach Rail
Replace Bridge
Approach Slab
NameNumber
Exist(ft)
RRR Std(ft)
Prop(ft) (Y/N) Exist
(ft)
RRR Std(ft)
Prop(ft) (Y/N) (Y/N) (Y/N) #
Remarks:
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Add remarks.
4D. Traffic Data
Present Year ADT
Construction Year ADT 10-Year ADT
DHV 20-Year ADT
D % Trucks
*T.I. (10-Year) ESAL (10-Year)
*T.I. (20-Year) ESAL (20-Year) * Must correlate with T.I. in Materials Report
Safety Field-Review (date)
Latest 3-Year Collision Data: (average vs. actual rates)
Location(s) of Collision Concentration:
Corrective Strategy:
Discuss.
4E. Materials
Discuss.
5. CORRIDOR AND SYSTEM COORDINATION
Discuss.
6. ALTERNATIVES
6A. Rehabilitation strategy:
Discuss.
6B. Design exceptions:
Discuss.
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6C. Hazardous waste disposal site required? If yes, where are sites?
Discuss.
6D. Material and/or disposal site need and availability?
Discuss.
6E. Highway planting and irrigation:
Discuss.
6F. Roadside design and management
Discuss.
6G. Stormwater compliance:
Discuss.
6H. Right-of-way and utility issues:
Discuss.
6I. Railroad involvement:
Discuss.
6J. Salvaging and recycling of hardware and other non-renewable resources:
Discuss.
6K. Prolonged temporary ramp closures:
Discuss.
6L. Recycled materials:
Discuss.
6M. Local and regional input:
Discuss.
6N. What are the consequences of not doing this entire project?
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Discuss.
6O. List all alternatives studied, cost, reasons not recommended, etc.:
Discuss.
7. TRANSPORTATION MANAGEMENT
7A. Transportation Management Plan
Discuss.
7B. Vehicle Detection Systems
Discuss.
8. ENVIRONMENTAL COMPLIANCE
Discuss.
Date Approved:
9. PROJECT ESTIMATE
Repeat STRAIN Work table for each structure. Do not include capital outlay support in the estimates. If the estimate for a specific item is duplicated in another item, show estimate in parenthesis and add a note. Add additional rows/lines as needed.
Pavement WorkLane Miles Number Estimate
Total Lane-Miles of Rehabilitation _______
Flexible Overlay of Flexible Pavement(recycle not included) (1, 2) _______ _________
Rigid Overlay of Flexible Pavement _______ _________
Hot Recycled AC (1, 2) _______ _________
Cold Recycled AC (1, 2) _______ _________
Reconstruct Lane(s) _______ _________
Crack Seal & Flexible Overlay of Rigid Pavement (2) _______ _________
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Rigid Overlay of Rigid Pavement (2) _______ _________
Rigid Pavement Rehabilitation(list appropriate work type: grind, slab replacement, spall repair, grout & seal random cracks, lane replacement, joint seal, etc.)
_______ _________
Ramps _______ _______ _________
OC/UC and Bridge Approaches (list appropriate work type: grind, replace, etc.) _______
Edge Drain (side mi) _______ _________
Subtotal _________
Notes:1. Include cost to remove and replace localized failed areas.2. Include cost of shoulder backing material for increased thickness at shoulder edge, as needed.
STRAIN Work – Enter structure number here
Estimate
List Work Items _________
List Work Items _________
Subtotal _________
Does the Project Include:
Yes/No Estimate
Main Line Widening (lanes and/or shoulders) _______ _________
Bridge Widening and Rail Upgrade _______ _________
Included in ProjectDeferred (why)
_______
Bridge Rail Upgrade - Without Widening _______ _________
Included in ProjectDeferred (why)
_______
Vertical Clearance Adjustment _______ _________
Drainage Rehabilitation(list appropriate work type: roadbed surface, roadside off-site, subsurface, etc.)
_______ _________
Pedestrian Facilities _______
Alternations Required (list): _______ _________
Traffic Control _______ _________
Other(identify: e.g., mobilization, hazardous waste compliance, etc.) _______ _________
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Subtotal _________
Safety
Yes/No Estimate
Rumble Strip _______ _________
Superelevation/Cross Slope Correction _______ _________
Vertical Alignment _______ _________
Horizontal Alignment _______ _________
Left/Right-Turn Storage/Widening/Lengthening _______ _________
Signal Upgrade _______ _________
Median Barrier (state type: e.g., PCC, Thrie Beam) _______ _________
Metal Beam Guardrails (new) _______ _________
Concrete Guardrail (new) _______ _________
Roadside Cleanup _______ _________
Gore Cleanup _______ _________
Electroliers _______ _________
Subtotal _________
Roadside Management
Yes/No Estimate
Gore Area Pavement _______ _________
Pavement beyond Gore Area _______ _________
Miscellaneous Paving _______ _________
Maintenance Vehicle Pull-outs _______ _________
Off-Freeway Access (gates, stairways, etc.) _______ _________
Roadside Facilities _______ _________
Subtotal _________
Totals Estimate
Pavement Work Subtotal _________
STRAIN Work Subtotal _________
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Does the Project Include Subtotal _________
Safety Subtotal _________
Roadside Management Subtotal _________
Sum of Subtotals _________
20% Contingency _________
Mobilization _________
TOTAL PROJECT ESTIMATE _________
10. FUNDING/PROGRAMMING
Funding
Discuss the project funding and include one of the following statements:
It has been determined that this project is eligible for Federal-aid funding.
Or
It has been determined that this project is not eligible for Federal-aid funding.
Programming
If the project is already programmed, include the data for comparison and discuss how the proposed estimates compare to the current programmed amounts.
Discuss if project has been combined.
Complete the table for each funding source. Consult with the project manager to determine the fiscal funding year, the escalated estimates, and the escalation rates. Enter funding source, estimates, adjust fiscal year designations as needed, and state any key assumptions including the escalation rates used.
Fund Source Fiscal Year Estimate20.XX.201.### Prior 14/15 15/16 16/17 17/18 18/19 19/20 Future Total
Component In thousands of dollars ($1,000)PA&ED SupportPS&E SupportRight-of-Way SupportConstruction SupportRight-of-Way
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ConstructionTotal
State the support cost ratio. Consult with the project manager to determine the support cost ratio.The support cost ratio is ##.##%.
11. DELIVERY SCHEDULE
Project Milestones Milestone Date(Month/Day/Year)
Milestone Designation
(Target/Actual)PROGRAM PROJECT M015BEGIN ENVIRONMENTAL M020NOTICE OF PREPARATION (NOP) M030NOTICE OF INTENT (NOI) M035CIRCULATE DED EXTERNALLY M120PA & ED M200PS&E TO DOE M377DRAFT STRUCTURES PS&E M378RIGHT OF WAY CERTIFICATION M410READY TO LIST M460FUND ALLOCATION M470HEADQUARTERS ADVERTISE M480AWARD M495APPROVE CONTRACT M500CONTRACT ACCEPTANCE M600END PROJECT M800
M030 is only required when there is an EIR environmental document, M035 is only required when there is an EIS environmental document, M120 is only required if there is a draft environmental document that will be released to the public, and M378 is not required, but optional if there are structures involved, delete rows as needed. The Milestone Designation column may be deleted when all the milestone dates are in the future.
12. RISKS
Summarize information from the risk register.
13. EXTERNAL AGENCY COORDINATION
Federal Highway Administration (FHWA)
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Discuss if the project has been identified as a “Project of Division Interest” or “Project of Corporate Interest.”
Discuss project actions, as appropriate, assumed by Caltrans and any coordination with the FHWA for review and approval of project actions.
If the project proposes new or modified Interstate access, include a discussion of any issues and the proposed or actual dates for the Determination of Engineering and Operational Acceptability and Final Approval.
The project requires the following coordination:
The following is a list of common entities that Caltrans coordinates with on projects, delete and add to the list as appropriate.
US Army Corps of EngineersDepartment of the Army Permit for:
Clean Water Act Section 404Rivers and Harbors Act of 1899 Section 9Rivers and Harbors Act of 1899 Section 10
General Permits (Regional Permit, Nationwide Permit or Programmatic Permit)Standard Permits (Individual Permit or Letter of Permission)Section 9 Permit
United States Coast GuardRivers and Harbors Act of 1899 Section 9Bridge Permit
California Department of Fish and WildlifeCalifornia Fish and Game Code Section1602Lake or Streambed Alteration Agreement
California Coastal Commission and/or Local Coastal ProgramCalifornia Public Resources Code Division 20 (California Coastal Act)Coastal Development Permit
California State Lands CommissionCalifornia Public Resources Code Division 6Permit
Central Valley Flood Protection BoardCalifornia Water Code Division 5, Part 4Encroachment Permit
Regional Water Quality Control Board
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Clean Water Act Section 401Water Quality Certification
San Francisco Bay Conservation and Development CommissionCalifornia Government Code Title 7.2California Public Resources Code Division 19Major Permit, Administrative Permit, or Regionwide Permit
Local AgencyCooperative Agreements with
Local AgencyAgreements with
RailroadsRailroad Agreement for at-grade or separated-grade crossings
OtherSpecify
14. PROJECT REVIEWS
Scoping team field review Date Scoping team field review attendance roster attached.District Program Advisor Enter Name Date Headquarters SHOPP Program Advisor Enter Name Date District Maintenance Enter Name Date Headquarters Project Delivery Coordinator Enter Name Date Project Manager Enter Name Date FHWA Enter Name Date District Safety Review Date Constructability Review Date Other Date
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15. PROJECT PERSONNEL
List the project personnel, such as:
Name, Title Phone #
16. ATTACHMENTS (Number of Pages)
List attachments with the number of pages, such as:
A. Location map (1)B. Storm Water Data Report-signed cover sheet (1)
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